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Leadership Grand Rounds


Generals, Admiral Talk Readiness, Interoperability

By Bernard S. Little
WRNMMC Command Communications

Walter Reed Bethesda hosted its second Leadership Grand Rounds on Feb. 6 featuring the current and two former Joint Staff Surgeons. The JSS serves as the chief medical advisor to the Chairman of the Joint Chiefs of Staff, the Joint Staff and the Combatant Commanders.
Retired Air Force Lt. Gen. (Dr.) Douglas J. Robb, retired Army Maj. Gen. (Dr.) Joseph Caravalho, Jr., and the current Joint Staff Surgeon Navy Rear Adm. (Dr.) Colin G. Chinn, discussed the priorities of readiness versus delivering the benefit; interoperability for the future; and scalable platforms and the medical mission in support of an operational force during the event at WRB.
Navy Capt. (Dr.) Mark A. Kobelja, director of Walter Reed National Military Medical Center, said Robb, Caravalho and Chinn "truly, deeply and profoundly understand the complexity of research and education in an academic medical center while delivering high-quality health care. At the same time, they have spent many years focused in the Joint Force (JF) medical team [on] interoperability, lethality, battlefield survivability, consequence management, infectious disease, marshalling forces, and figuring out how to tie all that together with logistics." 
Kobelja explained that the generals and admiral provided WRNMMC with a challenge of "picking up the mantle and doing our part in setting the battlespace. What can we do at Walter Reed Bethesda beyond perform ourselves, capturing casualties and caring for them? What's our role in setting the battlespace?," the WRNMMC director said.
All three featured speakers emphasized the importance of having a "ready medical force...medically ready force" with "shared joint and service responsibility."
"Future medical interoperability, [with] efficiency driving effectiveness, requires more joint solutions," Robb stated. "Interoperability and effective integration of service capabilities enhance joint operations to accomplish U.S. government objectives," he said.
An aerospace medicine specialist who served as the JSS from September 2010 to June 2013, Robb said the "age-old" questions concerning the Military Health System are: "Should the MHS be primarily a 'readiness' model or a 'business' model, and does the 'readiness' model support the 'business' model or does the 'business' model support the 'readiness' model?'"
"The answer is...yes!," Robb continued. "They're not two separate things. You've got to fly the sorties. You've got to steam the ship. You've got to go to the range." For the MHS, this means maintaining currency and proficiency in the operating room and clinics to stay ready for wartime to provide casualty care on the battlefield, in ship hospitals and austere environments.
Advancements in medicine and readiness by those in the MHS to treat casualties have resulted in declining wartime U.S. lethality rate throughout history. During the Revolutionary War, U.S. lethality rate was approximately 45 percent, which decreased to about 10 percent during Operation Enduring Freedom/Operation Iraqi Freedom, Robb explained. He credits the decrease to “the value of joint responsibility [and] the transformation of combat casualty care.”
Caravalho, who served as the JSS from December 2015 to August 2017, agreed that readiness and increased joint efforts are paramount for the MHS and its survivability. He added warfighters on the battlefield demand a ready, highly-capable medical team in support.
A nuclear medicine physician and cardiologist, Caravalho said, "I believe each service should own its capability, but at some point, we've got to come together." He added that following the U.S. invasion of Grenada in 1983 and the Goldwater-Nichols Department of Defense Reorganization Act of Oct. 4, 1968, the services "went from independent to interoperable. "We've progressed to become interdependent." He said the next step for those in the MHS is to be interchangeable.
"Tactically, you ought to be beholding to your services and understand [its] nuances. But once you get from the tactical to the operational and we're in a tent, in a fixed facility or doing clinical work, it shouldn't matter. We should be interchangeable. I think we'll retain relevance in that setting, or we'll die separately if we don't come together," Caravalho said. "If you want to maintain your independence, independently agree to the same thing because the only one who thinks Army, Navy or Air Force medicine is Army, Navy and Air Force medicine. Everyone above you [and] everyone outside of you thinks of it as 'DoD medicine.' You've just have to come to grips with that," he added.
"I'm not here to protect [any one service's] equity," agreed Chinn, who succeeded Caravalho as the JSS in August 2017. He added that the mission of the Office of the JSS is to provide the Chairman and the Joint Staff the best military medical advice and synchronize health services to enable globally integrated operations of the JF. He explained globally integrated operations "is the concept for how the JF should prepare for the security environment we will soon face."
An internist, Chinn said cybersecurity is becoming "more and more important" to U.S. national security. "We have a multipolar world [with] probably the most challenging security environment we've had in decades," he furthered.
Threats and challenges to U.S. security include "a rising China, a resurgent Russia, a North Korea that is rapidly developing nuclear weapon capability, Iran continuing to cause problems throughout the globe, and extremist organizations [worldwide]," Chinn said. These five concerns are not confined to a particular region, but pose global threats, he added.
Chinn explained that facing these threats "requires a globally postured JF that is able to quickly combine capabilities with itself and mission partners across domains, echelons, geographic boundaries and organizational affiliations to project decisive military force." He added being able to combine unique service capabilities to project decisive military force "has always been the strength of the JF. We, as a medical community, have to adjust and adapt to the environments to support our warfighters [doing those missions]."
Caravalho agreed, adding, "You're not in uniform because you're the 'world-renowned blank-ologist. You're in uniform because there's an 18-year-old [who may someday need you for care on the battlefield, on a ship hospital or transport aircraft]. That's what you bring to the fight. That's going to be your success going forward -- always answering what we do and why is it that we are doing whatever we would for the good of the warfighter,” he said.
"Demonstrate to DoD that you are a part of DoD," Caravalho concluded.